Fatal denial: Muslims and AIDS

July 12, 2005|Laura M. Kelley and Nicholas Eberstadt | Laura M. Kelley was the principal author of the 2002 National Intelligence Council study, "The Next Wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India and China." Nicholas Eberstadt is a scholar at the American Enterprise Institute. A longer version of this article appears in the July/August issue of Foreign Policy.

"I just pray that God ends my life ... before more symptoms show. I don't want to create problems for my family."

Before his HIV-positive diagnosis in 2001, the Egyptian engineer who spoke these words thought that AIDS was a faraway disease that afflicted only foreigners. He had no idea that the global AIDS pandemic had reached his desert home. Now he says he would rather kill himself than be rejected -- along with his family -- by neighbors and friends, who regard HIV as synonymous with sin and shame.

To Americans, suicide may seem like a disproportionate response to a diagnosis of HIV/AIDS. But as the disease spreads across the Islamic world, such stories are not uncommon. In parts of Iran, nearly 60% of those infected with HIV kill themselves within a year of diagnosis. In Kerman, in southern Iran, an enraged father not long ago took an ax and chopped his 23-year-old to pieces for bringing AIDS into his family.

A generation into the world HIV epidemic, it is still impossible to describe the magnitude of the AIDS problem in the Islamic world with any accuracy. According to the Joint United Nations Program on HIV/AIDS, there are about 61,000 people infected with HIV in Iran; 180,000 in Indonesia; 150,000 in Pakistan. In the Islamic countries of Africa, the numbers are far higher: Mali alone has 420,000 infected people. But the latest U.N. data is telling for its lack of information -- a handful of cases here, empty columns there. And absence of information has too long been interpreted as absence of infection.

This much is clear: The disease is spreading quickly, and without proper prevention and treatment, many more Muslims will become infected and die.

AIDS is not new to the Islamic world; the first cases were recorded in the mid-1980s. But few countries have mounted comprehensive infection-surveillance programs, much less taken the appropriate steps to help prevent or treat the disease. One major reason for this has been the ludicrous tendency of many of these nations to insist that their people do not engage in premarital sex, adultery, prostitution, homosexuality or intravenous drug use -- or to suggest that such activities occur so infrequently that the risk of the disease gaining a foothold is low.

This, coupled with the lack of infection control, is allowing HIV to spread from high-risk to lower-risk groups. In Tamanrasset, Algeria, for instance, 1% of women reporting to a prenatal health clinic for routine checkups tested positive, indicating that the disease already had become established enough in the community to infect married women with no known risk factors.

To date, two Islamic countries have achieved limited successes in the fight against HIV/AIDS: Bangladesh and Iran. In Bangladesh, much of the work has been done by nongovernmental organizations; in Iran, outgoing President Mohammad Khatami and his administration led the fight. Tehran created national programs to educate young people about disease transmission and about how to protect themselves. It has also strengthened drug treatment programs and experimented with needle purchase and exchange programs. Perhaps most significantly, Iran has passed laws to protect the legal rights of those infected and to ensure them proper treatment at hospitals and job security.

Unfortunately, these efforts far outpace those of many other Islamic countries. Little or no data is available in many countries with significant higher-risk populations -- Afghanistan and Iraq among them. Saudi Arabia and other Persian Gulf states, after decades of blaming foreign workers and visitors for the disease, have only recently admitted that they have a small but persistent domestic locus of infections. Levant states are also slow to address problems even though they have high levels of prostitution and sizable but unacknowledged populations of gay and bisexual men.

Islamic countries must begin by mounting aggressive surveillance programs that reach all their citizens -- including sex-sellers and drug abusers, among others, and not just those who ask to be tested or those who suspect they might already be infected.

Unchecked, HIV and AIDS will continue to spread through Islamic countries -- destroying families and deepening poverty until it has rent the very fabric of these vulnerable societies. AIDS is no longer a simple matter of humanitarian assistance. The pandemic has become a global security issue of the utmost importance and must be addressed by all nations as such -- or AIDS will win.